RADIOLOGY/NUCLEAR MEDICINE
ADPAC GUIDE
(Package Implementation and Maintenance)
Version 5.0
December 1999
(Revised June 2017)
Department of Veterans Affairs
VistAHealth System Design and Development
Revision History
Date / Page / ChangeJuly 2002 / V-8, V-13, V-16 / Added a Division Parameter for HL7 Applications
July 2002 / IX-41 / Added HL7 Radiology Menu
September 2002 / VII-45 / New entries and modifications to existing entries are prohibited without approval from Radiology Service VACO.
September 2002 / VII-89 / Added new option VistaRad Category Entry/Edit
September 2002 / VIII-39 / Added new option VistaRad Category Print
May 2003 / V-2 / Patch RA*5*34: Inserted paragraphs regarding if parameter is set to NO or not answered at all.
May 2003 / VII-6 / Patch RA*5*34: Moved ‘PRINT ON ABNORMAL REPORT’ entry up to align with top of row.
May 2003 / VII-64 / Patch RA*5*34: Inserted text regarding semicolon restriction on procedure name.
May 2003 / XIV-5 / Patch RA*5*34: Inserted text regarding several cases sharing one printset.
March 2004 / VII-2, 3, 68, 69, VIII-21, 32, XI-1, XII-5, XVII-1, XVII-6 / Patch RA*5*45: Inserted text regarding no longer using AMIS codes to identify contrast medial use, and associating parent/descendant procedures that use contrast media.
December 2004 / VIII-22-28, 32, 35, 37, 40, 43 / Patch RA*5*45. Inserted documentation for new Procedure File Listings: HIST Display Rad/NM Procedure Contrast Media History and List of Procedures with Contrast.
Inserted a Note for several Procedure File Listings that contrast media associations will display, when appropriate.
December 2016 / V-3,4,10
VII-82 / Patch RA*5*133. Document changes to Reason Enter/Edit and Division parameter Set-up.
June 2017 / IX7-8
V-35
VII-28 / Patch RA*5*137. Documentation added for new item on the RA HL7 Menu.
Add Registered Request Printer to ‘Location Parameter List’ [RA SYSLOCLIST] output.
Add pregnancy screen to Exam Status Tracking example.
Table of Contents
I.Introduction
Implementation Checklist
Supervisor Menu
Division, Location, Imaging Type Definitions
☞Parent/Descendent Exam and Printsets
☞Radiopharmaceuticals
II.Implementation Check List
Update from V. 4.5 to V. 5.0
Virgin Installation (no previous version installed or implemented)
III.Screening Methods
IV.Security Keys
RA ALLOC
RA MGR
RA VERIFY
V.System Definition Menu
Division Parameter Set-up
Division-wide Order Entry Parameters
Exam Entry/Edit Parameters
Films Reporting Parameters
Miscellaneous Division Parameters
HL7 Applications Associated with this Division
Imaging Locations Associated with this Division
Print Division Parameter List
Camera/Equip/Rm Entry/Edit
List of Cameras/Equip/Rms
Location Parameter Set-up
Flash Card, Jacket Labels, and Exam Label Param
Order Entry Parameters
Report Parameters
Cameras/Equip/Rooms Used by this Location
Default CPT Modifiers used by this Location
Recipients of the 'Stat' Alert for this Location
Imaging Type for this Location
Location Parameter List
VI.Rad/Nuc Med Personnel Menu ...
Classification Enter/Edit
Clerical List
Interpreting Resident List
Interpreting Staff List
Technologist List
VII.Utility Files Maintenance Menu...
Complication Type Entry/Edit
Diagnostic Code Enter/Edit
Examination Status Entry/Edit
Exported Setup
Example Status Tracking Sessions
Film Type Entry/Edit
Label/Header/Footer Formatter
Major AMIS Code Entry/Edit
☞Nuclear Medicine Setup Menu
☞Lot (Radiopharmaceutical) Number Enter/Edit
☞Route of Administration Enter/Edit
☞Site of Administration Enter/Edit
☞Vendor/Source (Radiopharmaceutical) Enter/Edit
Order Entry Procedure Display Menu ...
Common Procedure Enter/Edit
Create OE/RR Protocol from Common Procedure
Display Common Procedure List
Procedure Edit Menu ...
☞Cost of Procedure Enter/Edit
Procedure Enter/Edit
Procedure Message Entry/Edit
Procedure Modifier Entry
Reason Edit
Reports Distribution Edit
Sharing Agreement/Contract Entry/Edit
Standard Reports Entry/Edit
Valid Imaging Stop Codes Edit
VistaRad Category Entry/Edit
VIII.Maintenance Files Print Menu ...
Complication Type List
Diagnostic Code List
Examination Status List
Film Sizes List
Label/Header/Footer Format List
Major AMIS Code List
Modifier List
☞Nuclear Medicine List Menu ...
☞Lot (Radiopharmaceutical) Number List
☞Route of Administration List
☞Site of Administration List
☞Vendor/Source (Radiopharmaceutical) List
Procedure File Listings ...
☞HIST Display Rad/NM Procedure Contrast Media History
Sample Contrast Media Edit History by Procedure Report
Active Procedure List (Long)
Active Procedure List (Short)
Alpha Listing of Active Procedures
☞Barcoded Procedure List
Inactive Procedure List (Long)
Invalid CPT/Stop Code List
List of Inactive Procedures (Short)
☞List of Procedures with Contrast
☞Parent Procedure List
Procedure Message List
Series of Procedures List
Report Distribution Lists
Sharing Agreement/Contract List
Standard Reports Print
VistaRad Category Print
IX.Radiology HL7 Menu
Rad/Nuc Med HL7 Voice Reporting Errors
Resend Radiology HL7 Message
Send ADT HL7 message to PACS
X.Worksheets
Division Parameters
Camera/Equip/Room
Location Parameters
Classification
Blank Examination Status Worksheet
Procedure Setup
☞Radiopharmaceuticals
Example Radiopharmaceutical Drug Classifications
☞Nuclear Medicine Setup
XI.☞Parent/Descendent Exam and Printsets
Definition
Common Data for Printsets
Non-Common Data for Printsets
Single Report Setup for Printsets
Special Character Designation for Printsets
HL7 Interface
Registration
Editing Data
Labels, Headers, Footers
VA Fileman Prints/Inquiries
Add Exams to Last visit
CPRS Interface for Printsets
Imaging/Multi-Media Interface Effects on Printsets
XII.Case Edits and Status Tracking
Overview
Taking Control
Stuffing Data and Default Responses
☞Radiopharmaceutical Logic
☞Medication Logic
☞Radiopharm Prescription & Prescribing Physician/Dose Logic
Population of Imaging Exam Data
XIII.Outpatient Workload Crediting
Imaging Stop Codes File 71.5
Invalid CPT/Stop Code List
Valid Imaging Stop Codes Edit
Location Parameter Edit
Options that can Potentially Trigger Crediting
Crediting
Errors
XIV.Troubleshooting
On-line Verifying of Reports
Reports
XV.Frequently Asked Questions
Imaging Types
Procedures
Case Numbers
Requesting/Scheduling Requests
Printing/Batching/Etc.
Purging Records
Verifying Reports
Hold/Cancelled/Pending/Scheduled
Doubling Workload Credit
Effect of Portable and Operating Room Modifiers
Complications
Contracting Out
Research
General Editing Helpful Hints
XVI.☞Stop Task (TaskMan)
XVII.Glossary
XVIII.Index
March 2005Radiology/Nuclear Medicine V.5.0 ADPAC Guide1
Introduction
I.Introduction
As application coordinator, you are required to build, customize, and maintain the Radiology/Nuclear Medicine module files to meet the specific needs of your site. This document is provided to assist you in this function.
☞ / This icon designates something as being new or changed in some way from the previous version.Implementation Checklist
We suggest using the checklist to make sure you do not miss any necessary steps in implementation. If your site implemented version 4.5, use the Update V. 4.5 to 5.0 Installation Checklist. If this is a first time installation or setup of this program, use the Virgin Installation Checklist.
Supervisor Menu
Options are shown using their external name (the name users see) with the internal name in brackets. This is an example of what you might see:
Division Parameter Set-up
[RA SYSDIV]
There are four main menus used for implementation and maintenance of this software. The IRM Menu which Information Resource Management handles also plays a roll in implementation, but it is addressed in the technical manual. Each option in the four menus is explained in the following chapters. They are exercised during implementation and throughout the use of the software to maintain or update the files.
- The first menu is the System Definition Menu. It contains options to set up and view Division and Imaging Location parameters and to add new cameras, equipment, or rooms to the system.
- The second is the Rad/Nuc Med Personnel Menu in which you can enter or edit the classification and access of clerks, technologists, residents, and staff. It also contains print options to obtain a listing of each of these categories.
- The third is the Utility Files Maintenance Menu which contains options to add and edit:
Complication types
Diagnostic codes
Exam statuses activation and parameters
Film types
Label/header/footer formats
Major AMIS codes (use only if authorized by VA HEADQUARTERS)
Nuclear Medicine parameters
Order entry procedures
Procedures and their characteristics
Procedure messages
Procedure modifiers
Reasons for cancellation
Report distribution queues
Sharing agreements and contracts
Standard reports
Valid imaging stop codes
- The fourth, the Maintenance Files Print Menu is used in conjunction with these add/edit options to display the contents of the files.
Diagnostic Code List / Clerical List / Division Parameter
Set-up / Diagnostic Code Enter/Edit
Examination Status List / Interpreting Resident List / List of Cameras/
Equip/Rms / Examination Status Entry/Edit
Film Sizes List / Interpreting Staff List / Location Parameter List / Film Type Entry/Edit
Label/Header/
Footer Format List / Technologist List / Location Parameter
Set-up / Label/Header/
Footer Formatter
Major AMIS Code List / Print Division Parameter List / Major AMIS Code Entry/Edit
Modifier List / Nuclear Medicine Setup Menu
Nuclear Medicine List Menu / Order Entry Procedure Display Menu
Procedure File Listings / Procedure Edit Menu
Report Distribution Lists / Reason Edit
Sharing Agreement
/Contract List / Reports Distribution Edit
Standard Reports Print / Sharing Agreement
/Contract Entry/Edit
Standard reports Entry/Edit
Valid Imaging Stop Codes Edit
Division, Location, Imaging Type Definitions
There are three terms you must be familiar with in order to understand how this package functions. They are Division, Imaging Type, and Imaging Location.
A Division is defined as a major unit of an institution which requires separate management. In most instances, there is only one Division at a given medical center which is also referred to as the site. Integrated sites usually require at least one Division defined per site. The Division Parameter Set-up and Location Parameter Set-up options allow you to tailor the package to fit the particular needs of your department. All parameters are specific to the Division, which allows you, as the coordinator, to select the parameters you want to utilize with either a YES or NO answer.
An Imaging Location is defined as a physical location where a procedure can be performed. Each location has its own set of parameters defining location-specific criteria, e.g., label/header/footer formats, printer devices for flash cards, jacket labels requests and reports and how many labels to print. An Imaging Location may be associated with only one Division and only one Imaging Type.
An Imaging Type must be assigned to each procedure and each Imaging Location. Therefore, many Imaging Types can be active within a single Division. Imaging Types other than General Radiology and Nuclear Medicine should only be "activated" if they indeed are Imaging Types used at your facility and report procedures and/or workload separately from the other Imaging Types. In other words, if you want CT scans to be on separate workload reports rather than on General Radiology workload reports, then you should activate the CT Scan Imaging Type (by associating locations that do CT Scans with the Imaging Type of CT scan and assigning CT scan procedures an Imaging Type of CT Scan). Imaging Types are limited in this package to the following:
IMAGING TYPEABBREVIATION
Angio/Neuro/InterventionalANI
Cardiology Studies (Nuc Med)CARD
CT ScanCT
General RadiologyRAD
Magnetic Resonance ImagingMRI
Nuclear MedicineNM
UltrasoundUS
Vascular LabVAS
MammographyMAM
You should not attempt to add any additional Imaging Types to the above list.
It is important to know how to activate an Imaging Type. When at least one Imaging Location and one or more procedures have been assigned a new Imaging Type, that Imaging Type becomes "active".
Below is a schematic showing relationships:
Division, Imaging Location, Imaging Type, and Camera/Equipment/Room Relationships
Note:The Imaging Type of any given procedure will determine in which Imaging Locations it may be registered and performed. Example: If the Imaging Type for procedure X is General Radiology, it can be registered in Imaging Locations A, B, and D.
☞Parent/Descendent Exam and Printsets
A major enhancement to this version is a single combined report for a set of related procedures. This is a "printset" mechanism for entering a single report for all descendent cases registered from a parent order (See Procedure Enter/Edit for more information on parent procedures). For more detailed information see Parent/Descendent Exams and Printsets. The ability to create a separate report for each procedure ordered under a single parent procedure still exists.
☞Radiopharmaceuticals
Another important addition with this version is the ability to enter and edit information specific to radiopharmaceuticals for Nuclear Medicine. A new menu, Nuclear Medicine Setup Menu under the Utility Files Maintenance Menu, allows the site to define parameters for radiopharmaceuticals concerning lot number, route and site of administration, and source/vendor. The addition of radiopharmaceutical fields has a major effect on case and status edits for Nuclear Medicine and Cardiology Studies Imaging Types. For more complete information, refer to the chapter Case Edits and Status Tracking.
March 2005Radiology/Nuclear Medicine V.5.0 ADPAC Guide1
Implementation Check List
II.Implementation Check List
Update from V. 4.5 to V. 5.0
This implementation checklist assumes that you have fully implemented version 4.5 and now want to review for implementation the new functionality available in this version.
Before IRM loads this version into production:
a. Review the Release Notes to acquaint yourself with any changes that were made to this version of the software and update the users to those changes.
b. Review all new items in this manual (those designated by☞) and read the chapters on Single Reports for Parent/Descendent Exams and Printsets and Case Edits and Status Tracking. Also, Procedure Enter/Edit in this manual and Report Entry/Edit and Diagnostic Code and Interpreter Edit by Case No. in the user manual are affected by printsets.
c. Radiology/Nuclear Medicine accesses the Pharmacy Drug file #50 for radiopharmaceuticals and their associated VA Classifications; therefore, the Drug file must contain all the radiopharmaceuticals used at your site. Provide the Pharmacy ADPAC with a list of the radiopharmaceuticals and work with the ADPAC to enter them into the Drug file. When entering Radiopharmaceuticals into the Drug file, it is recommended to enter the Nuclide then the Pharmaceutical as the Drug Name and also a synonym to make it easier for Radiopharmaceuticals to be retrieved. (See Example Radiopharmaceutical Drug Classifications under the chapter Worksheets.)
The Radiopharmaceuticals should be assigned one of the following VA Classifications under Diagnostic Agents:
DX200 Radiopharmaceuticals, Diagnostic
DX201 Imaging Agents (in vivo), Radiopharmaceuticals
DX202 Non-Imaging Agents Radiopharmaceuticals
d. If a status's Order is removed through the Examination Status Entry/Edit option but the Appear on Status Tracking field is set to YES, exams in that status will, after the installation of version 5.0, be available for edit in Status Tracking of Exams. The inactivated status will be processed after the active statuses. The purpose of this feature is to allow processing of exams to complete if they are in an inactive status and the case edit options do not prompt for the required fields to allow data entry to complete the cases. If your site has a large volume of historic cases that fall into this category, you may want to make sure the Appear on Status Tracking field is set to NO prior to the installation of this version.
e. Print the Active Procedure List (Short) to get a list of Nuclear Medicine procedures that can be used to fill out your worksheets for procedure set-up.
f. It will be necessary to train the technologists and transcriptionists in handling case and report entry/edits for printsets. This should be done in your training account prior to installing live.
The technologists must be made aware of the following:
1)If an exam is added through the Add Exam to Last Visit option, and the last visit was a printset/parent, the added exam becomes part of the printset. The report will be a single one even if the added exam is quite different from the substance of the parent.
2)If there are two parent requests of the same Imaging Type, do not use the Add Exam to Last Visit option to add the procedures of the second parent to the first. Doing this will create a single report for all procedures from both parents, and the second request will never be completed because all descendants will apply to completing the first request.
While you do the setup required after installation, Imaging Service users must be off the system. You should prepare as much as possible to minimize the downtime for Imaging Service users.
The following is a listing and discussion of all the new functionality that you may want to edit in setting up this version. It is strongly suggested that you review the following checklist and complete any worksheets prior to the actual setup. Then use the completed checklist and worksheets during the setup.
1)❑Division Parameter Set-up.
a. AUTO E-MAIL TO REQ. PHYS? -If you want to automatically send Radiology/Nuclear Medicine findings when they are verified to the requesting physician via e-mail, you need to enter YES in this field.
Division / E-Mail Findingsb. RPHARM DOSE WARNING MESSAGE - If you want to display a message other than the default message
This dose requires a written and signed directive by a physician.
to the user when the radiopharmaceutical dose falls outside the range of the "Low Adult Dose" and the "High Adult Dose", enter the message here. These fields reside in the Default Radiopharmaceuticals multiple in the Rad/Nuc Med Procedures file. Use the Procedure Enter/Edit option to adjust these values.